Life expectancy after initiation of combination antiretroviral therapy in Thailand

Abstract

Background: Access to combination antiretroviral therapy (cART) has decreased mortality in HIV-positive people. We aimed to estimate the expected additional years of life in HIV-positive Thai people after starting cART through the National AIDS Program (NAP), administered by the Thai National Health Security Office (NHSO).

Methods: The NHSO database collects characteristics of all Thai HIV-infected patients through the National AIDS Program, including linkage with the National Death Registry for vital status. This study included patients aged ≥15 years at cART initiation between 2008 and 2014. The abridged life table method was used to construct life tables stratified by sex and baseline CD4⁺ T-cell count. Life expectancy was defined as the additional years of life from age at starting cART.

Results: 201,688 eligible patients were included in analyses, contributing 618,837 person-years of follow-up. Median CD4⁺ T-cell count was 109 cells/mm³ and median age 37 years. The overall life expectancy after cART initiation at age 20 was 25.4 (95% CI, 25.3, 25.6) years and 20.6 (95% CI, 20.5, 20.7) at age 35 years. Life expectancy at baseline CD4⁺ T-cell count ≥350 cells/mm³ was 51.9 (95% CI, 51.0, 52.9) years for age 20 years and 43.2 (95% CI, 42.4, 44.1) years for age 35 years, close to life expectancy in the general Thai population.

Conclusions: Increasing life expectancy with higher baseline CD4⁺ T-cell counts supports the guideline recommendations to start cART irrespective of CD4⁺ T-cell count. These results are beneficial to forecast the treatment cost and develop health policies for people living with HIV in Thailand and Asia.